Prior to seeing my patient who was admitted with Type 2 Respiratory Failure, I checked the medical chart for his cardiovascular status. I noticed that his SpO2 was at 97% with 2L entrained Oxygen via a BiPAP machine. This raised concern, as the patient would have relied on hypoxic drive to breathe considering his diagnosis. This meant that a small rise in his oxygen levels could have caused a huge reduction in his ventilatory drive, which could have resulted in further deterioration of his resp status. In addition, I recalled that the doctor had specifically noted that his SpO2 should be targeted at 88-92% on BiPAP.
The ward nurse didn’t seem to know anything about the situation, and I was not sure if I was allowed to adjust the setting on the BiPAP machine. So I approached the NIV physiotherapist, whom happened to be in the ward that morning, to seek guidance. Immediately, she notified the nurse and requested that the flow be adjusted to ensure his SpO2 was within the targeted level.
I was reminded that, as a clinician, it is essential that I am thorough with my examination of a patient and be analytical in every situation because this could ultimately prevent any unnecessary mishap. Also, it is important to approach the most suitable clinician in seeking the most appropriate step to take.
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I agree with you Fenny. As clinicians, we should always make sure that we do no harm to the patient. And to let someone who has hypoxic drive to breath to have an SpO2 of 97 is potentially harmful to the patient if not identified earlier. We should always pay attention to every little details regarding our patients and to act accordingly when something isn't right.
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